Defining Death

When is a human being actually and legally dead? Until a few years ago, physicians assumed that death occurred after the heart stopped beating. Now most doctors agree that an individual dies when the brain does, and last week the American Bar Association adopted a similar standard. As a guide to determining brain death, many doctors--and the Kansas and Maryland state legislatures--have adopted a set of standards suggested in 1968 by researchers at Harvard University. These require, among other things, that doctors wait at least 24 hours after an electroencephalograph (EEG) has shown no brain activity, then check again. If the second EEG is as flat as the first, the doctor can then assume that even if machines are keeping the patient breathing, his brain, and thus the patient, has died.

A study conducted for the National Institute of Neurological Diseases and Stroke now questions whether so long a wait is necessary. Dr. Benjamin Boshes, chairman of the department of neurology at Northwestern University and spokesman for the study group, says that a patient whose brain shows no activity for at least 30 minutes is "as dead as he ever will be." As a result, Boshes and his colleagues are proposing a new definition of death.

Gruesome Work. The study bases its recommendation on a long research project ("three years of the most gruesome work," according to Boshes) conducted by doctors from nine institutions under a grant from N.I.N.D.S. The researchers studied 503 seriously ill or severely injured patients whose brains had apparently stopped functioning. In each case, the doctors determined whether this lack of brain activity was caused by a drastically lowered body temperature, by drugs (tranquilizers, heroin, or barbiturates mixed with alcohol can result in a flat EEG), or by injuries or ailments. They also tested the patient's ability to respond to various stimuli (most unconscious people, for example, will blink at a loud noise) and found out whether they could breathe unaided. When temperature and drugs had been ruled out and there were no signs after 30 minutes that the brain was working, it was decided that a patient had indeed suffered brain death. Of 459 such patients, none recovered despite the efforts of their physicians. "It's life ex machina," says Boshes. "At that point, the only thing keeping anything alive is the respirator; the brain itself is irrevocably dead."

Boshes would like to see the new criteria replace those now used to determine death. So would many of his colleagues, who are urging that the suggested standards be made law in IIlinois. This could reduce the delays that often occur in transplant operations, in which doctors generally wait 24 hours before taking organs from donors. It could also reduce the time that patients with no hope of recovery are now kept alive by machines--at great financial and emotional cost to their relatives.

This file is automatically generated by a robot program, so viewer discretion is required.